Two-thirds of appendix operations may be unnecessary and could be treated
simply by using antibiotics, according to a new study.

Medical "dogma" and 130 years of tradition mean doctors often wrongly consider surgery to be the only course of action, academics write in the British Medical Journal.

They say there is now good evidence that treating "uncomplicated" cases of appendicitis with antibiotics tends to be better for the patient than surgery.

Uncomplicated appendicitis, where an inflammed appendix has not led to other problems such as perforation of the organ or a serious infection, account for 80 per cent of cases. The other 20 per cent are complicated cases, where surgery really is the only option.

Researchers wanted to see how patients with uncomplicated appendicitis fared if put on antibiotics instead of operated on.

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Among those given antibiotics, 80 per cent did not suffer another bout of appendicitis within 12 months of their course.

Consequently, just under two-thirds (64 per cent) of all appendectomies could be regarded as unnecessary.

The researchers, from the Nottingham Digestive Diseases Centre NIHR Biomedical Research Unit, said that while appendectomy had been the "mainstay" treatment since it was first reported in 1889, antibiotics had been unfairly "overlooked".

They wrote: "The role of antibiotic treatment in acute uncomplicated appendicitis may have been overlooked mainly on the basis of tradition rather than evidence."

They said routine early appendectomy was based on the "dogma" that "appendicitis is a progressive disease, from an uncomplicated stage to one with complications of gangrene, perforation, or peritonitis, and that any delay in treatment increases the risk of complications."

They concluded: "Initial antibiotic treatment merits consideration as a primary treatment option for early uncomplicated appendicitis."

However, commenting on the research, Dr Olaf Bakker from the Department of Surgery at the University Medical Center Utrecht in the Netherlands, said treating appendicitis with antibiotics had "major certain disadvantages".

In particular, he thought the fact one in five ended up having appendicitis again within 12 months was quite high.

Until more convincing and longer term results were published, "appendectomy for uncomplicated appendicitis will probably continue", he said.